They created an advocacy group to help Chicago-area consumers, including themselves, with the most basic questions. Among the most popular: Are my favorite doctors and hospitals covered by any health plans as the networks of providers shrink?

It sounds like an easy answer, but four years after the public health insurance exchange launched, confusion remains rampant among Illinois consumers, small businesses and brokers alike. Insurers and hospitals negotiate reimbursement rates behind closed doors and can announce abrupt changes, leaving patients in a lurch about whether their favorite doctors and hospitals will be part of their insurer's network.

Take Northwestern Memorial HealthCare, one of the biggest local health systems that's popular among patients for its renowned specialists. The expensive academic medical center is only in Blue Cross & Blue Shield of Illinois' Blue Precision plan. Here's the only way to access one of its downtown specialists: trek to see one of its primary care physicians in the western suburbs and get a referral downtown, Northwestern spokesman Chris King says.

Jeannine Martin, who with her husband owns Skokie-based CoreBuilt Contracting, said she launched IL ACA Consumer Support on Facebook in July out of frustration after learning that any payments she made to Land of Lincoln Health before its collapse in October, including deductibles and annual out-of-pocket limits, wouldn't transfer to a new insurer. Land of Lincoln was among eight insurers in Illinois on the exchange in 2016, and folded amid big financial losses.

Martin, 39, and other former Land of Lincoln policyholders Miranda Wilgus, who works for the Joint Action Committee for Political Affairs, and Emily Burchfield, a licensed therapist, also launched a separate advocacy page, called ACA Consumer Advocacy, to address issues broader than dealing with the fallout from Land of Lincoln's demise. They've written letters to local lawmakers about suspect health plans and have sat down with officials at the Illinois Department of Insurance, including director Anne Melissa Dowling, to help people get claims issues resolved and learn how to buy plans off the exchange.

“There's all these advocacy groups out there . . . but there were no voices of consumers,” said Wilgus, 46, of North Chicago. “We were basically the ones being handed a menu (of health plans), and we felt that was wrong.”

As the Dec. 15 deadline to enroll in an exchange plan nears, much of the angst the advocacy group and others like it hear about is aimed at the lack of Chicago-area teaching hospitals in plans sold on the exchange.

Across the nation, more sick people signed up for plans than insurers anticipated. That fueled big losses at insurers, which led to premium hikes and carriers nixing expensive hospitals from their networks.

In Illinois, it's not just the networks that shrank. The number of insurers selling plans on the exchange for 2017 compared to this year has decreased too.

Ann & Robert H. Lurie Children's Hospital of Chicago, a prominent specialty hospital where 55 percent of patients are on Medicaid, was in the networks of four health insurers on the exchange in 2016. But all have left the marketplace, or closed (Land of Lincoln), leaving parents with seriously ill children scrambling to find another provider.

While Lurie has talked with insurers still on the exchange, “what they offered us is really not practical,” said Monica Heenan, chief strategy officer at the Streeterville-based hospital. She declined to name the insurers, or say how much they were offering.

For the roughly 200 Lurie patients who were covered by an insurer no longer on the exchange, yet have appointments booked for treatments like chemotherapy, the hospital is negotiating rates with insurers and working with state regulators to figure out how the patients' parents can pay for their treatment, Heenan said.

In a statement, Michael Batkins, a spokesman for the state insurance department, said the agency does not get involved in contract negotiations between health systems and insurers. But it does review all plans.

“Nationwide, there is a trend of narrowing networks, and Illinois is no exception,” the statement said. “DOI strives to provide all Illinois consumers as much information as possible in order for them to make an informed choice.”